Yu Sawada1,2, Kota Sahara1,2, Itaru Endo1,2, Katsunori Sakamoto1,3, Goro Honda1,4, Toru Beppu1,5, Kenjiro Kotake1,6, Masakazu Yamamoto1,7, Keiichi Takahashi1,8, Kiyoshi Hasegawa1,9, Michio Itabashi1,7, Yojiro Hashiguchi1,10, Yoshihito Kotera1,7, Shin Kobayashi1,11, Tatsuro Yamaguchi1,8, Ken Tabuchi1,12, Hirotoshi Kobayashi1,13, Kensei Yamaguchi1,14, Satoshi Morita1,15, Soichiro Natsume1,8, Masaru Miyazaki16, Kenichi Sugihara17. 1. Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan. 2. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan. 3. Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan. 4. Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan. 5. Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, Japan. 6. Department of Surgery, Sano City Hospital, Sano, Tochigi, Japan. 7. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan. 8. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan. 9. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan. 10. Department of Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan. 11. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa-shi, Chiba, Japan. 12. Department of Pediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan. 13. Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, Japan. 14. Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan. 15. Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Japan. 16. International University of Health and Welfare, Mita Hospital, Minato-ku, Tokyo, Japan. 17. Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
Abstract
BACKGROUND/ PURPOSE: The purpose of the present study was to assess long-term outcomes following liver resection for colorectal liver metastases (CRLM) with concurrent extrahepatic disease and to identify the preoperative prognostic factors for selection of operative candidates. METHODS: In this retrospective, multi-institutional study, 3820 patients diagnosed with CRLM during 2005-2007 were identified using nationwide survey data. Data of identified patients with concurrent extrahepatic lesions were analyzed to estimate the impact of liver resection on overall survival (OS) and to identify preoperative, prognostic indicators. RESULTS: Three- and 5-year OS rates after liver resection in 251 CRLM patients with extrahepatic disease (lung, n = 116; lymph node, n = 51; peritoneal, n = 37; multiple sites, n = 23) were 50.2% and 32.0%, respectively. Multivariate analysis revealed that a primary tumor in the right colon, lymph node metastasis from the primary tumor, serum carbohydrate antigen (CA) 19-9 level >37 UI/mL, the site of extrahepatic disease, and residual liver tumor after hepatectomy were associated with higher mortality. We proposed a preoperative risk scoring system based on these factors that adequately discriminated 5-year OS after liver resection in training and validation datasets. CONCLUSIONS: Performing R0 liver resection for colorectal liver metastases with treatable extrahepatic disease may prolong survival. Our proposed scoring system may help select appropriate candidates for liver resection.
BACKGROUND/ PURPOSE: The purpose of the present study was to assess long-term outcomes following liver resection for colorectal liver metastases (CRLM) with concurrent extrahepatic disease and to identify the preoperative prognostic factors for selection of operative candidates. METHODS: In this retrospective, multi-institutional study, 3820 patients diagnosed with CRLM during 2005-2007 were identified using nationwide survey data. Data of identified patients with concurrent extrahepatic lesions were analyzed to estimate the impact of liver resection on overall survival (OS) and to identify preoperative, prognostic indicators. RESULTS: Three- and 5-year OS rates after liver resection in 251 CRLM patients with extrahepatic disease (lung, n = 116; lymph node, n = 51; peritoneal, n = 37; multiple sites, n = 23) were 50.2% and 32.0%, respectively. Multivariate analysis revealed that a primary tumor in the right colon, lymph node metastasis from the primary tumor, serum carbohydrate antigen (CA) 19-9 level >37 UI/mL, the site of extrahepatic disease, and residual liver tumor after hepatectomy were associated with higher mortality. We proposed a preoperative risk scoring system based on these factors that adequately discriminated 5-year OS after liver resection in training and validation datasets. CONCLUSIONS: Performing R0 liver resection for colorectal liver metastases with treatable extrahepatic disease may prolong survival. Our proposed scoring system may help select appropriate candidates for liver resection.